Access to health care for older persons in the United States: Personal, structural, and neighborhood characteristics

Objective: To determine the contributions of personal, structural, and neighborhood characteristics to differential access to health care for older persons in the United States. Methods: This study used the 1994 National Health Interview Survey, ages 65 and older (n = 12,341), 1990 census block group data, and data on health professional shortage areas. Logistic regression was used to model the probability of problems accessing care. Results: The likelihood of access problems increased sharply with decreasing gradients of family income and for those lacking private health care insurance. Rural areas and poor areas were at a disadvantage in accessing care, whereas residents of neighborhoods that were homogeneous in ancestral heritage appeared better able to access care. Discussion: Considering the high association between neighborhood and personal characteristics. it is notable that any neighborhood effects remained after combining them with personal effects.